Perfectionism and psychopathology: a review of research and treatment

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Abstract

Clinical experience suggests that perfectionism can impede the successful treatment of psychological disorders. This review examines the concept of perfectionism, critically evaluates its assessment, reviews the association between existing measures of perfectionism and psychopathology, and considers the impact of perfectionism on treatment. It is concluded that existing measures do not reflect the original construct of perfectionism and that, consequently, new measures are needed. The evidence reviewed indicates that high personal standards are specifically elevated in patients with eating disorders and beliefs about others' high standards for the self are associated with a broad range of psychopathology. The importance of examining mean scores across studies (as well as associations between variables within studies) is emphasized. There has been no systematic evaluation of the treatment of perfectionism despite existing cognitive-behavioral treatment protocols.

Section snippets

The concept of perfectionism

Hollender (1978) was among the first to define perfectionism, and he considered it as “the practice of demanding of oneself or others a higher quality of performance than is required by the situation.” Hollender considered perfectionism as a neglected personality trait, yet shortly after this description Burns (1980a) provided a broad analysis of the concept, describing perfectionism as a “network of cognitions” that included expectations, interpretations of events, and evaluations of oneself

The development of perfectionism

There is some consensus about how perfectionism develops among those who have theorized about perfection and it is concluded that “perfectionism has its roots in interactions with parents who are perfectionistic and demanding” (Frost, Lahart, & Rosenblate, 1991, p. 470). A number of different parenting approaches have been associated with perfectionism (Hamachek, 1978; Burns, 1980), and these have been described as four types of early experience that contribute to the development of

Assessment

Two self-report measures consider perfectionism as multidimensional and both scales are called the Multidimensional Perfectionism Scale (MPS). These scales were developed by Frost et al. (1990) and by Hewitt and Flett (1991a) and are described below.

Dimensions of perfectionism across the disorders

The next section presents a description of the major studies that have examined the relationship between perfectionism and psychopathology. Summaries of these findings are presented in Table 1, Table 2.

Impact of perfectionism on the treatment of depression

There are empirical data demonstrating that perfectionism (measured with the Dysfunctional Assumption Scale) impedes the successful treatment of depression, regardless of treatment modality Blatt et al., 1995, Blatt et al., 1998. The treatment of depression collaborative research program (TDCRP) was a large-scale investigation into the effects of four brief treatments, one of which was cognitive therapy Elkin et al., 1989, Imber et al., 1990. The other treatment conditions were interpersonal

Conclusion

This review leads to several conclusions concerning the (1) concept of perfectionism, (2) its assessment, (3) associations with psychopathology, and (4) its treatment.

First, with regards to the concept of perfectionism, we conclude that the current measurement of perfectionism does not reflect the original construct. Fundamental to the original construct of perfectionism is the pursuit of excessively high personal standards and rigid adherence to them. Implicit in this definition is that

Acknowledgements

The authors are grateful for the helpful comments of C. G. Fairburn, Z. Cooper, M. Fennell, S. Rachman, and the reviewers of the paper. Both authors are funded by the Wellcome Trust (055112).

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